Painful fatigue

Excessive lethargy leaves a young woman barely able to get out of bed

Gina is a 34-year-old woman who reports 12 months of fatigue associated with arthralgia and myalgia.


Her medical history includes appendicectomy and subclinical hypothyroidism. She takes thyroxine and cranberry tablets.

She has had routine thyroid function tests done, and her TSH was 11.7mIU/L initially, then 20.1mIU/L (normal range 0.4-3.5mIU/L) on repeat measurement.

She was commenced on thyroxine a few months prior. Her latest TSH is 6.72mIU/L.

Gina also has oligomenorrhoea, with periods every 30-60 days. She had 6-7 periods in the past year.